Eligibility for
Unique Circumstances

There are several situations when you’re eligible for Medicare Parts A and B that are not automatic and conventional. Some people have to sign up for Part A and/or Part B.

Unique Circumstances We Can Help With:

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If you’re close to 65, but NOT getting Social Security or Railroad Retirement Board benefits, you’ll need to sign up for Medicare. You will NOT get it automatically. Contact Social Security three months before you turn 65. You can also apply for Parts A and B at ssa.gov/benefits/medicare.

If you worked for a railroad, contact RRB. In most cases if you don’t sign up for Part B when you’re first eligible, you may have a delay in getting Medicare coverage in the future. In some cases this can be over a year and you may have to pay a late enrollment penalty for as long as you have Part B.

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If you have End-Stage Renal Disease (ESRD) and you want Medicare, you’ll need to sign up. Again, contact Social Security to find out how and when to sign up for Parts A and B.

Get more information by calling Social Security at 1-800-772-1213. If you worked for a railroad or get RRB benefits, call 1-877-772-5772. TTY users can call 1-312-751-4701.

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If you’re not automatically enrolled you can sign up for Part A once your initial enrollment period begins. Your Part A coverage will start 6 months before the month you apply for Medicare, (or Social Security/RRB benefits), but NO earlier than the month you turn 65. 

Remember, in most cases, if you don’t sign up for Part A (if you have to buy it) and Part B when you’re first eligible, you may have to pay a late enrollment fee.

When Can I Sign Up?

Special Enrollment Periods

After your Initial Enrollment Period (IEP) is over, you may have the chance to sign up for for Medicare during a Special Enrollment Period (SEP).

If you didn’t sign up for Part B or Part A (if you have to buy it) when you were first eligible because you’re covered under a group health plan (with 20 or more employees) based on current employment (your own, a spouse’s, or a family member’s, if you have a disability), you can sign up for Part A and/or Part B:

  • Anytime you’re still covered by the group health plan
  • During the 8-month period that begins the month after the employment ends or the coverage ends, whichever happens first

Usually, you don’t pay a late enrollment penalty if you sign up during a Special Enrollment Period. This Special Enrollment Period doesn’t apply to people who are eligible for Medicare based on End-Stage Renal Disease (ESRD). It also doesn’t apply if you’re still in your Initial Enrollment Period.

If you have a disability, and the group health plan coverage is based on the current employment of a family member, the employer offering the group health plan must have 100 or more employees for you to get a Special Enrollment Period.